I was pleased on Monday to read “Innovation, Health and Wealth”, the report of the review into innovation in the health service led by Sir Ian Carruthers. In October I called for a debate in Westminster Hall on the subject of innovation in the NHS. The statement by the Secretary of State for Health, Andrew Lansley MP, made clear that the government appreciate the value and importance of innovation to the future of the UK’s health service. As the Carruthers report explains, innovation in the NHS has the capacity both to save lives and drive up standards of care in the health service, but also to promote efficiency and reduce the cost burden of treatments and procedures.
I argued in October that the current processes to capitalise on innovation are simply not quick enough, and there are insufficient incentives and mechanisms to innovate. The recommendations of the Carruthers report are very welcome and will go some way to addressing this. The shared savings formula and a system of payment for outcomes act will develop real incentives to innovate. The focus on making the uptake of innovation “quicker and smarter” – by developing close relationships between industry, the Medical Research Council, and the Technology Strategy board, and introducing processes to fast-track NICE-approved treatments onto the hospital floor – is also particularly welcome.
I was particularly interested in Andrew Lansley’s recognition of a new prevailing research model, based upon collaboration, early clinical trials, and a willingness to outsource. I have two observations to offer on this theme that should complement and extend the reforms outlined on Monday.
First, the measures that have been announced focus on using NHS resources to encourage innovation in the private sector – such as anonymous patient data and use of clinical trials – and ensuring any innovative technologies and treatments are swiftly adopted and diffused. However, if we are to take a truly collaborative approach we must surely make use of the expertise of clinicians and technicians within the health service, and encourage innovation to come from within the NHS. Successful innovations could be made commercially available and accrue revenue streams to the NHS. This is the real challenge of innovation: unlocking the potential that lies within the existing institutions. The role of innovation hubs to promote innovation from within the health service received relatively little attention but could form a significant part of future reform efforts. The review on NHS Intellectual Property Strategy is also a good opportunity to address this side of the challenge of innovation.
Second, if a modern research and innovation model is to succeed, we have to understand the crucial role of leadership. The Carruthers review focussed on Board-level leadership and specified commitments to promote innovation, but this needs to extend to a fundamental cultural change. The systematic exploitation and adoption of good ideas, and the ability to bring ideas to a point of commercial viability, should become “second nature”.
The review found that the chain from an initial idea to widespread use across the health service was too long. A fear of failing has stunted the adoption and promotion of innovative ideas. We need a culture in the health service that is not paralysed by a fear of failure, so that individuals are prepared and feel able to take risks, but also take responsibility. This is a central virtue of private enterprise that should find its way into the heart of the NHS.
The recommendations of the Carruthers review are a welcome start to tackling the challenge of innovation in the health service, but they should be complemented and extended by a focus on innovation within the NHS, and a creation of a culture that is not afraid of risk-taking or of possible failure. It is there that the greatest potential for efficiency and higher standards lies.